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I <br /> F <br /> FALL PROTECTION CHECK LIST <br /> SITE LOCATION <br /> Check type of Fall Protection being used. <br /> Stay and Lay Policy(Leading Edge) <br /> Mobile Scaffolds <br /> _ Stationary Scaffold <br /> _ Wood Pole Scaffold <br /> Frame Scaffold Access <br /> — Tube and Coupler Scaffold <br /> — System Scaffold <br /> ___- Metal Carpenter Bracket <br /> Pump Jack Scaffold <br /> House Scaffold <br /> Bricklayers Square Scaffold <br /> Vebicle-Mounted Elevating Platform <br /> Boom Supported Platform <br /> Manual-Propelled Elevating Platforms <br /> _ Self-Propelled Elevating Platforms <br /> i <br /> _ Motion Stopping Systems j <br /> z <br /> Guardrails <br /> Fall Protection Harness,Lanyards etc. l' <br /> Safety Net 1 <br /> s <br /> Warning Systems <br /> Safety Monitoring System <br /> Special Fall Protection <br /> Supervisor Signature ' Date <br /> i <br />